PSY240 2. Assessment Flashcards
Purpose of Assessment
used to diagnose
establish a baseline
understand nature of problems
Purpose of Assessment
=identify strengths (things to draw on)
e.g. good verbal communication - psychodynamic therapy
weaknesses
aid in treatment planning - apply treatment effectively with proper diagnoses
Gathering Information: Symptoms and History
• Current symptoms
how much they interfere with functioning
how do they cope?
how much distress?
Gathering Information: Symptoms and History
• Recent events negative events recently are these events tied to the symptoms somehow e.g. PTSD Gives insight to level of functioning
Gathering Information: Symptoms and History
-e.g. adjustment disorder impairment due to recent event avoiding overpathologizing normal events • History of psychological disorders have they experienced similar symptoms in the past? need to see symptoms over course of life
Gathering Information: Symptoms and History
-e.g. psychotic disorders
schizo gets diagnosed if 6 months or later
bipolar disorders - hypomanic or depressive episodes then they can’t get diagnosed with a unipolar disorder such as depressive disorders
Gathering Information: Symptoms and History
-• Family history of psychological disorders
insight on childhood, genetic vulnerabilities
e.g. perceptual abnormalities with family history of schizo - categorize them as high risk
Physiological and Neurophysiological Factors
• Physical Condition
do they have medical disorders?
e.g. underactive thyroid - similar symptoms as depressive
if they can be treated with medication, then it’s not MDD
• Drug and Alcohol Use
might cause or exacerbate symptoms
e.g. substance induced depressive disorder
might be on medication that is not to be mixed with what they’re going to be prescribed
are there cognitive deficits that might cause symptoms
e.g. youth - anxiety of school: may be better treated with learning disability
when considering 2/+ disorders
try to tease out potential symptoms and more specific symptom presentation
Physiological and Neurophysiological Factors
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Physiological and Neurophysiological Factors
• Intellectual and Cognitive Functioning • Important for differential diagnosis
Gathering Information: Sociocultural Factors
• Social Resources
Gathering Information: Sociocultural Factors
-• Sociocultural Background
• Acculturation
Gathering Information: Sociocultural Factors
do they have friends and family? how much contact? what’s the relationship like?
social support can be a protective factor and buffer to alleviate stress
practice multicultural competence
don’t diagnose as abnormal if normal in cultural background
to what extent do they identify with heritage or host culture?
e.g. ambivalence over conflict with traditional parent and culture of peers-
Gathering Information: Sociocultural Factors
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Gathering Information: Sociocultural Factors
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Approaches to Classification
Categorical Approach
– ALL criteria must be met; Assumes unique etiology
Approaches to Classification
Prototypical approach
– MOST criteria must be met (DSM) Dimensional approach
Approaches to Classification
-– Characteristics of disorders can vary in severity
– Psychopathology represents extremes on a continuum
Approaches to Classification
- have to have 5 symptoms present
e. g. downsyndrome: trisomy 21
not assume that all are met
e.g. MDD: 5/9 symptoms
are you depressed?
most natural characteristics distributed among pop as normal curve
categorical understands it at the extremes - statistically unlikely
e.g. how depressed are you?
Approaches to Classification
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What Best Describes Patients?
-are they better described on a continuum or as categories?
What Best Describes Patients?
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What Best Describes Patients?
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Categories vs. Dimensions
Dimensions show superior psychometric properties – 15% increase in reliability
– 37% increase in validity
Categories vs. Dimensions
based on analytic studies
why doesn’t DSM use it?-
Categories vs. Dimensions
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Scale Construction
Articulate construct and content.
Choose response format. Assemble initial item pool.
Scale Construction
Collect data
Examine psychometric properties and quality
Scale Construction
Final scale
Scale Construction
-be specific: definitions may be different
is it gonna be yes/no or a rating scale from 1-5
generating potential questions
if it doesn’t work out then go back to step 1
once satisfactory we use final scale in research
Scale Construction
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Important Assessment Characteristics: Validity and Reliability
-reliable, but not valid - same results, but not measuring the construct
reliable and valid
unreliable and hence not valid
Important Assessment Characteristics: Validity and Reliability
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Important Assessment Characteristics: Validity
Type l Description
Face l Test measures what it is supposed to measure
Important Assessment Characteristics: Validity
Construct l Test measures what it is supposed to measure and not something else
Content l Test assesses all important aspects of phenomenon
Important Assessment Characteristics: Validity
Concurrent l Test yields the same results as similar measures
Predictive l Test predicts what it is supposed to measure
Important Assessment Characteristics: Validity
=meaningfulness and usefulness of the scale
construct: e.g. highly correlated with depression, not somatic complaints
GRE: expected to be correlated with IQ, not with gender
e.g. physical symptoms and distress levels
both criterion
external measure we’re comparing it to
take existing valid test and testing correlation
comparing with something that’s in the future
e.g. comparing IQ with GRE in the future
Important Assessment Characteristics: Validity
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Important Assessment Characteristics: Reliability
Type l Description
Test-Retest l Test produces similar results when given at two points in time
Important Assessment Characteristics: Reliability
Alternate Form l Two versions of the same test produce similar results
Internal l Different parts of the same test produce similar results
Important Assessment Characteristics: Reliability
consistency and repeatability
temporal stability
e.g. IQ - beginning and end of class, thought to be stable
diff versions should achieve same results
components of same test: e.g. first half same results as second half
diff interviewers - do they have same diagnostic conclusion?
critical consensus to get most helpful treatment
reliability is necessary, but not sufficient for validity-
Important Assessment Characteristics: Reliability
Interrater or Interjudge l Two or more raters or judges who administer a test to an individual and score it come to similar conclusions.
Important Assessment Characteristics: Reliability
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Inter-rater Reliability
Subject Rater Outcome
Client => Dr. X =>
Inter-rater Reliability
-Bipolar Disorder Bipolar Disorder/Schizo good internal reliability
not reliable assuming similar skills and training
Inter-rater Reliability
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Inter-rater Reliability
Client => Dr. Y
Inter-rater Reliability
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Assessment Tools: Clinician-Rated Tools
The Clinical Interview
• Intake interview: gather info on person’s life
– Usually focuses on presenting problem
Assessment Tools: Clinician-Rated Tools
– Structured, semi-structured, or unstructured
Assessment Tools: Clinician-Rated Tools
• Limitations of Interviews
– Resistance from the client
Assessment Tools: Clinician-Rated Tools
– Selective information provided by the client
Assessment Tools: Clinician-Rated Tools
-what symptoms brought you here?
structured: specific questions - pulled for responses that are more concrete
e.g. have you been feeling down
unstructured: open ended
e.g. how are you feeling
semi-structured: in between
interviews tough especially first time
e.g. looking to obtain services from insurance
embellish symptoms
e.g. present selves in best possible light
parents for custody
Mental Status Exam
Components
- Appearance and behavior
- Thought Processes
Mental Status Exam
- Mood and affect
Mental Status Exam
- Intellectual functioning
Mental Status Exam
- Sensorium
Mental Status Exam
-1. e.g. groomed overt, observable behaviour what they’re wearing, posture, behaviour 2. rate, continuity, content of speech does it make sense? is it cohesive? 3. predominant feeling state 4. extent of vocabulary metaphor and abstract ability 5. awareness of surroundings aware of person, place or time
Assessment Tools: Behavioural Observations and Self-Monitoring
• Behavioural Observation
– Problems with inter-rater reliability
e.g. how they behave in class, interact with peers and teacher
operationalize construct - clear definition of what we’re looking for
improve inter-rater reliability
e.g. track how many cigarettes they’re smoking
prone to self-report biases
Assessment Tools: Behavioural Observations and Self-Monitoring
– Must “operationalize” the behaviour
Assessment Tools: Behavioural Observations and Self-Monitoring
• Self-Monitoring
– Open to self-report bias
Assessment Tools: Behavioural Observations and Self-Monitoring
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Assessment Tools: Behavioural Observations and Self-Monitoring
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Projective Tests
• Rorschach Inkblot Test
Projective Tests
• Thematic Apperception Test (TAT)
Projective Tests
• The Sentence Completion Test
Projective Tests
• Draw-A-Person Test
Projective Tests
-Rorschach Inkblot: what they see
detailed scoring method based on human movement, use of colour, location
Thematic Apperception Test: what is happening in this picture
tell dramatic stories
Sentence Completion: e.g. my mom is ____
Draw-a-person
ambiguous and open ended
Freudian: tap into unconscious
draw inferences from themes
concerns with reliability and validity - open to human interpretation error
Assessment Tools: Projective Tests
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Assessment Tools: Projective Tests
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Assessment Tools: Projective Tests
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Assessment Tools: Projective Tests
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Objective Tests
• What makes them objective?
– Results are independent of evaluator bias
Objective Tests
– Standardization
• Examples
– Intelligence tests (WAIS-III, WISC-III)
Objective Tests
– Achievement tests (WIAT-III; WRAT-4)
– Neuropsychological tests (D-KEFS; NEPSY)
– Questionnaires (MMPI-II, PAI; BDI-II; CBCL)
Objective Tests
-IQ
school
memory, processing skills, inhibition
Personality and symptoms
Objective Tests
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Objective Tests: Intelligence Tests
- Used to determine strengths and weaknesses
* Help place and determine resources for children
Objective Tests: Intelligence Tests
-• Results
– Test-by-test (e.g., e.g., Vocabulary, Digit Span)
Objective Tests: Intelligence Tests
-– Composite Scores (e.g., Verbal Comprehension, Working
Memory, Processing Speed, Perceptual Reasoning)
– Full Scale IQ (overall intellectual functioning)
Objective Tests: Intelligence Tests
-gifted vs. learning disability
placement
8-12 tests - tap into different abilities
e.g. blocks, identify images
Objective Tests: Intelligence Tests
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Intelligence Tests
Example Subtest: Matrix Reasoning
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Intelligence Tests
Example Subtest: Matrix Reasoning
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Intelligence Tests
Example Subtest: Matrix Reasoning
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Intelligence Tests
Example Subtest: Matrix Reasoning
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Objective Tests: Intelligence Tests
Criticisms
• Little agreement on definition of intelligence
Objective Tests: Intelligence Tests
-• Most tests only assess verbal and analytical abilities • Biased toward middle and upper-class educated